出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction : In July 2015, HealthPathways HP was implemented by a Local Health District and a Primary Health Network. Type 2 Diabetes T2DM was identified as a priority area. HealthPathways is a dynamic online health information portal aimed at General Practitioners GPs. It supports integration by bringing together general practice and hospital-based clinicians to develop agreed local pathways. It provides guidance for assessment, management, and referral of diverse conditions linked to local resources. New pathways are constantly developed and existing pathways regularly reviewed. Methods : The study used a programmatic approach and mixed-methods including literature reviews, site visits, semi-structured interviews stakeholders and GPs, and surveys GPs and patients to understand the development, implementation and acceptance of T2DM pathways. Electronic surveys were analysed using SPSS Version 20. Cronbach’s alpha was calculated to assess internal consistency of Likert scales responses. Interviews were digitally recorded, transcribed and evaluated using NVivo10 for thematic analysis. Initial codes were abstracted further to identify concepts and categories to generate final themes. Results : 57 GPs responded to the electronic survey. 86% reported awareness of HP and 30% had used diabetes pathways. Of those using diabetes pathways : Over 80% reported it improves quality of care, keeps them informed and supports diagnostic processes 93% agreed information is of high quality and practical 68% reported improvement in referral quality 87% reported assisted in providing more health care in the community and made their job easier Access, workflow and perceived utility were reported as barriers to use Patient survey data including wait times, frequency of clinic and emergency department visits and hospitalisations will form a baseline for later evaluations. **Preliminary analysis of the 12 stakeholder interviews has identified: Implementation Enablers: Key stakeholders’ commitment Seamless networks and collaboration between parties Clear processes and accountabilities Facilitating Factors: Identified as an effective and practical tool with high quality information Supports diagnostic process and patient management Improves referral and triage process for secondary care. Barriers : Longer consultations Prior knowledge and beliefs of health professionals Access difficulties i.e. username/password Increasing size and overly prescriptive nature of website Availability of other online resources Lack of content awareness and how it will add to the consultation/management of patients. Discussion : This preliminary analysis suggest that those who use HP have found it to be a practical tool that supports their diagnostic and referral processes and provides information of high quality. However, there may be a lack of awareness of the HP within general practices. Conclusions : HP is reported to be an effective tool which has improved referral and triage process for secondary care. It helps in improving patient outcomes and management. Lessons : Early evaluation of the pathways can only provide information on development and project implementation, rather than clinical outcomes. Study Limitations : Small survey sample size; Low GP recruitment Suggestions for Future : Broader scope for evaluation of multiple pathways to identify the best ways of ensuring sustainability, identify outcomes related to patient care and provide lessons for other regions. **NOTE: Currently on final stages of qualitative data analysis.
